Our research, published today in the journal Human Fertility, suggests the money being made from IVF could be subtly changing the advice doctors give.

Informed consent

Although IVF is a well-established procedure, it is not without its risks.

These include ovarian hyperstimulation syndrome, where hormone levels rise too much (causing abdominal swelling, nausea, vomiting and diarrhoea); obstetric complications such as premature delivery; and psychological distress, especially if the process fails.

Although long-term outcomes for children conceived using IVF appear to be similar to non-IVF children, questions remain about possible harmful impacts, including developmental abnormalities and cancer.

Given the financial, physical and psychological burdens of IVF, patients must be able to make informed decisions about whether to pursue these treatments in the first place, and when to stop.

A 30 year-old woman has a 40 per cent chance of a live birth after a single complete IVF cycle (so, after all viable embryos have been transferred). A 40 year-old woman, in contrast, may have a 10 per cent chance of a live birth following a complete IVF cycle.

The same 30 year-old might have a 70 per cent chance after six complete cycles, while the 40-year-old might only have a 25 per cent chance.

Success rates of IVF may appear deceptively higher if success is defined as clinical pregnancy (of just six to eight weeks), or live birth at a stage that is generally incompatible with sustained life (as early as 20 weeks or 400 grams).

Alternatively, rates may appear lower if they are reported per embryo transfer rather than per complete cycle.

To investigate this question, we conducted in-depth interviews with a range of professionals involved with ART in Australia, including obstetricians, policy advisers, researchers and counsellors.

Interviewees said financial motives were influencing ART practices in Australia, with some women offered IVF who don’t actually need it. Others are offered repeated cycles of treatment, even when they aren’t likely to succeed.

This dynamic was seen to be facilitated by the current Medicare system. The safety net protects patients by limiting the amount they have to pay out of pocket once they reach a certain threshold.

But it can also potentially encourage over-servicing and over-charging. There is no cap on the number of procedures that can be offered or the fees that can be charged.

Doctors can therefore offer additional services for higher fees without patients incurring significant additional costs. This has serious implications for the health system.

As one of the people interviewed in the study observed:

“I just think the business model and the fact that it takes advantage of Medicare, and the fact that the Medicare safety net helps spread the risk of out-of-pockets from the patient to the taxpayer is just basically being used to make some people a lot of money.”

Importantly, nobody who was interviewed suggested ART clinicians were deliberately misleading patients for their own financial benefit. The problem identified was subtler and reflected a deep ambivalence at the heart of medicine.

On the one hand, doctors are expected to be committed to their patients, research participants or the general public, and not concerned primarily with their own enrichment.

On the other hand, doctors need to earn a living and, in Australia at least, do so in a health system that supports — and even depends upon — publicly subsidised private practice.

There is no reason these interests are incompatible but their co-existence raises questions about how commercial interests may influence practice.

The commercialisation of ART raises questions not only about the motives and behaviour of clinicians, but also about how those seeking ART services should be viewed.

They could be seen as patients who are potentially highly vulnerable and to whom clinicians have a duty of care requiring them to play an active role in guiding patients in their healthcare choices even if this means some interventions are strongly discouraged.

Or they could be viewed as consumers free to choose whatever interventions they want in a healthcare marketplace, no matter how much they cost or how unlikely they are to succeed.

This idea is, of course, predicated on the assumption consumers will be provided with accurate information about risks, costs and benefits which, as many others have noted, cannot be assumed.

Although the Human Fertility study was small and does not represent the views of all professionals involved with ART in Australia, it reveals concerns about the impact of commercial interests in ART have not simply been drummed up by the media for dramatic effect.

It is time for an honest discussion about the Australian fertility industry, and about the role of money in medicine more generally.

Book an Appointment

Phone: 02 8305 9800
Email: gsacks@ivf.com.au

Important Disclaimer

Blog Articles that appear on this website do not reflect the opinions of Dr Gavin Sacks or any organisation that he may be affiliated with. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this site or found by following any link on this site, and this information should not be replied upon as medical, financial or legal advice. Always consult with a medical professional before taking any action.

The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information. This blog disclaimer is subject to change at anytime.

About Dr Gavin Sacks

Gavin completed his medical training at both Cambridge and Oxford Universities, including a degree in experimental psychology. He then trained further in clinical medicine in Leeds, Glasgow, London and Sydney.

At the same time, scientists were making ground-breaking advances in IVF technology. Gavin wanted to be a part of this medical revolution that was bringing real hope to infertile couples and is now one of Australia's leading IVF specialists.